My Life My Story: Dr. Piero Marco Fisichella

 

“Prioritize what is best for you at any stage and accept that that it might look different at various points in your life. Do it with both determination and humility, while not forgetting to take care of yourselves in the process.” – Piero Marco Fisichella, MD, MBA, FACS.

Biographic summary

Dr. Piero Marco Fisichella is an internationally renowned surgeon and researcher.

He obtained his medical degree from the University of Catania School of Medicine, in Italy, where he also completed his General Surgery training. He then moved to the US where he completed his research fellowship at the Center for the Study of Gastrointestinal Motility and Secretion at the University of California San Francisco, followed by General Surgery training at the University of Illinois at Chicago and a a fellowship in Minimally Invasive Esophageal and Bariatric Surgery at the University of California San Francisco. Following training he joined the faculty of the Department of Surgery of Loyola University, Stritch School of Medicine as Associate Professor and the Director of the Swallowing Center. He was then moved to Boston where he served as the Associate Chief of Surgery at the VA Boston Healthcare System, an Associate Professor of Surgery at the Harvard Medical School. He is currently working as a Medical Director in pharmacovigilance at a prominent pharmaceutical company, where he evaluates the safety profile of several oncology drugs and regimens.

Dr. Fisichella is a leader in the application of minimally invasive surgery for the treatment of benign esophageal diseases and the pathophysiology of gastroesophageal reflux disease and other benign esophageal disorders. He has authored hundreds of publications in peer-reviewed journals, as well as numerous book chapters, videos, and abstracts. He is the co-editor of two books: “The surgical treatment of benign esophageal disorders: the Chicago approach” and “Esophageal diseases: pathophysiology to treatment”. He has delivered hundreds of research presentations in national and international meetings. He has served as an Associate Editor of BMC Gastroenterology and in the Editorial Board of 5 peer-reviewed journals in surgery and gastroenterology, including the American Journal of Surgery and the Journal of Surgical Research. He has been Guest Editor for several peer-reviewed journals including Digestive and Liver Diseases and Surgical Laparoscopy Endoscopy and Percutaneous Techniques. He also served as peer reviewer for 11 journals on surgery and gastroenterology, including Annals of Surgery and JAMA. He has been the recipient of numerous awards and honors including Best Paper by New Member, Central Surgical Association, and Dean’s Office Clinical Scholar Award, Loyola University Stritch School of Medicine.

Dr. Fisichella has served as member in numerous scientific organizations including the American College of Surgeons, the Society of University Surgeons, the Society for Surgery of the Alimentary Tract, and the International Surgical Society. He directed a $4.5M Simulation Center at Loyola University Stritch School of Medicine. Dr. Fisichella also holds a master’s in business and administration from Northwestern University, Kellogg School of Management.

Interview

Q: Could we start with your background and early education?

A: I was born and raised in Catania, Italy, an ancient port-city on Sicily’s east coast that sits at the foot of Mt. Etna, an active volcano.

My father was a chemistry university professor, and my mother was a high school teacher with a degree in pharmacology. My parents’ profession had an important impact on me during my formative years, as it inspired in me the love for science, academic curiosity, and intellectual challenge.

Unsurprisingly, at the end of my high school I was planning to become a molecular biologist. I ended up going to medical school at the University of Catania as I thought it will give me more opportunities to apply scientific findings to patients. While at the beginning of the medical school I was open on what specialty to follow, my fourth year of the medical school was a defining year for me: my experience during surgical rotations was truly mesmerizing, and I fell with in love with surgery.

After medical school, I completed a mandatory one-year military service, where I was served as a lieutenant in the Italian Medical Corps. That experience further solidified my goal of becoming a surgeon. I then went on to complete the General Surgery training in Italy, which followed an apprenticeship model. Following residency training, through a connection with an Italian investigator, an opportunity came up to do research in esophageal surgery the Center for the Study of Gastrointestinal Motility and Secretion at the University of California San Francisco, where I completed a 2-year post-doctoral fellowship. At that time, I decided to continue my surgical career in the United States and embarked on a certification and retraining process that international medical graduates have to follow to practice in the United States. After passing my USMLE exams, I applied for a General Surgery residency position. I remember applying to all 225 residency programs that were available at that time a process that costed 1,750 dollars. I received 14 interviews, and ultimately matched at my first-choice program, the University of Illinois at Chicago, where I spent the most beautiful 5 years of my career. After residency, I went back to the University of California San Francisco to complete a fellowship in minimally invasive esophageal and bariatric surgery. I then started my first attending job and joined the faculty of the Department of Surgery of Loyola University.

Q: What has been the role of mentors in your career?

A: First, mentoring in the United States if very different than in Europe. In the US, mentors do not just give a professional advice or opinion; they are truly invested in supporting the mentees in all aspects of their life and career. As a result, people can have more than one mentor, a true team of mentors supporting the clinical and research progress of a person but also their personal growth. I was very fortunate to have as my mentor, Dr. Marco G. Patti, an internationally renowned minimally invasive esophageal surgeon, and investigator surgeon, himself an Italian surgeon and a graduate of University of Catania Medical School with a great and successful career in the US. He was truly influential in my life and career. He would always remind me that “In the US we take great pride in mentoring others. The success of our mentees it is our own legacy, and it validates our own success”.

Q: When looking back on your career, what were your characteristics that contributed to success in clinical work as well as education and research?

A: Curiosity, passion, and determination to pursue your goals. I would like to clarify here that determination does not mean stubbornness, arrogance, or lack of flexibility. It rather means to do everything that is in our power to reach our dreams.

Q: There is an increasing awareness on the importance of a healthy work-life integration for surgeons. What is your perspective on this issue?

A: The reason I left clinical surgery and went into pharmacology it has to do with this very issue, the unhealthy work-life balance. Of course, it depends on the institution where one works, but it is caused by an imbalance between our idealistic work as physician and healers with the productivity pressures, overregulation, and overwork. This ultimately leads to moral injury and burnout. Too often healthcare institutions care mostly about their financial profits and not about their most important assets: the humans behind their success – the physicians.

Q: Burnout affect an increasing number of surgeons,¹ and talking about this I no longer a taboo, but rather an imperative to better understand and improve it. Therefore, I greatly appreciate your candor, honesty, and courage to talk about your personal experience with burnout. As you know, there is of increasing number of surgeons who, due to burnout, leave surgery altogether,² with many of them going into a non-medical field. I can only imagine that such a transition, while very courageous, would be challenging. How was it for you? Any support and mentoring for this transition that you did when you were at the top of your very successful surgical career?

A: If one had asked me in the past what I would consider doing besides surgery, my answer would have been an unequivocal “nothing else, as surgery is who I am”. However, overwork and lack of appreciation led me to dissatisfaction. One of my friends who works for a pharmaceutical company and was witnessing what I was going through, suggested that I consider working for the pharmaceutical industry, and helped me with connections. I was reluctant to make the move at first, but what resonated with me was the focus on the wellbeing of their employees. So, I ended up making the transition focused on achieving for a balanced work and life while still contributing to the medical sciences and improving the health of patients. I am proud of what I do now because I feel I am helping people on a much larger scale rather than one at the time. When I first started the new pharma, I was worried and was expecting the reality to be different; however, I quickly realized that I could finally enjoy both work and life, after deferring taking care of myself for so long as surgeon. After all, as a side joke, MD stands not only for Medical Doctor, but also for “Must Defer”, as physicians often defer and delay taking care of themselves due to overwork. Studies have shown that surgeons not only use less of their vacation time, but 70% of them continue to complete work-related tasks even when they are on vacation.³ Furthermore, as I am sure you are familiar, as a Foreign Medical Graduate you are always expected to work more and harder. That adds another dimension to the burnout risks. However, I realized that we only live once, and work and life should be integrated in a healthy way.

Q: Your surgical career, your success as an International Medical Graduate, and your current transition to another field of work are all testaments of your resiliency. You are one of the most resilient people that I know. Where do you think your resilience comes from?

A: My resilience comes for the adversity that comes from a lack of opportunities. My options were very limited moving to a new country as an International Medical Graduate. My dilemma was very simple: You either succeed, or you succeed. There was no other alternative. I tried very hard and gave everything to achieve my goals.

Q: Do you have a favorite quote or mantra?

A: Yes, my favorite quote is the one by Bernard of Clairvaux⁴:

"There are those who seek knowledge for the sake of knowledge; that is Curiosity.

There are those who seek knowledge to be known by others; that is Vanity.

There are those who seek knowledge in order to serve; that is Love."

This great quote has always been my mantra, my life philosophy. Whether as a surgeon, a surgeon investigator, a pharma scientist, a friend, a colleague, a mentor, a partner, I always strive to help others. This is my true self.

Q: Any thoughts/plans/experience on giving back and remain connected to your country of origin in terms of clinical, research, and teaching expertise?

A: As a clinician and a researcher, I always looked for opportunities to help surgeons and investigators in Italy, but also help Italian surgeons who moved to the Unites States. In another example, I am currently helping one of my former University of Chicago surgery resident (who now is an attending surgeon) move to Italy with his Italian wife and navigate the surgical system there. Even now when I am working in pharma, I have helped establish collaboration with Italian pharmacology investigators for clinical trials.

Q: Any other important perspective that you would like to share with our readers?

A: I achieved everything that I planned as a surgeon. Although I am not doing surgeries any longer, whenever I am asked “Who/What am I?”, my answer always is “I am a surgeon”. That’s because that’s how I see myself, that is my identity. I still do things as a surgeon: efficient, determined, disciplined, and goal oriented. Surgical training is the best education that anyone can have, as it prepares you very well for all that life can bring.

However, now that I am doing something different, it does not mean that is better or worse than surgery in absolute terms. It is better for me at this stage of my life and career. And that is one important advice that I have: to prioritize what is best for you at any stage and accept that that it might look different at various points in your life. Do it with both determination and humility, while not forgetting to take care of yourselves in the process.